Collaborative Hospital Models For Shared Care And On-Demand Interconsultations. Which Offer The Best Results For Orthopaedic Surgery And Trauma?

Background and objectives: Hospitalized surgical patients are increasing in medical complexity, thereby increasing the need for support by internal medicine departments. This support is provided through interconsultations, which present problems that have resulted in the development of shared care (SC). Our objective was to compare the healthcare results achieved by the SC and interconsultation models in Orthopaedic Surgery and Trauma.Materials and methods: We conducted an observational, prospective, multicentre study of patients hospitalized for emergency Orthopaedic Surgery and Trauma recorded in the REINA-SEMI registry, treated by internal medicine departments through interconsultation or SC. We recorded the demographic characteristics, comorbidity, medical complications, hospital stay and mortality.Results: The study included 697 patients, 415 with SC and 282 with interconsultations. The SC patients were older (78.9 vs. 74.3; P < .001) underwent more operations (89.9 vs. 78.7%; P< .001), had fewer medical complications (50.4 vs. 62.8%; P< .001) and had shorter hospital stays (10 vs. 18 days; P< .001), with no differences in comorbidity or mortality. The following independent factors were associated with stays longer than 15 days: heart failure (OR 3.4; 95% CI 1.8-6.1; P < .001), the male sex (OR 1.9; 95% CI 1.2-3.1; P= .004), electrolyte disorder (OR 2.4; 95% CI 1.3-4.4; P= .003), respiratory infection (OR 1.9; 95% CI 1.04-3.7; P= .035), surgical delay (OR 1.1; 95% CI 1.08-1.2; P< .001) and treatment using the interconsultation on demand model (OR 3.5; 95% CI 2.3-5.4; P< .001).Conclusions: SC offers better healthcare results than interconsultations for patients hospitalized for emergency Orthopaedic Surgery and Trauma. (C) 2019 Elsevier Espana, S.L.U. and Sociedad Espanola de Medicina Interna (SEMI). All rights reserved.